Better Ways to Cut Healthcare Waste
Vložit
- čas přidán 17. 06. 2024
- A surprising amount of spending on healthcare in America is wasteful - we’ve talked about that before. In today’s episode, we discuss different approaches to reducing that waste, and potential barriers standing in the way.
Related HCT episodes:
1. Where is the Waste in Health Spending? • Where is the Waste in ...
Be sure to check out our podcast!
• Podcast
Other Healthcare Triage Links:
1. Support the channel on Patreon: vid.io/xqXr
2. Check out our Facebook page: goo.gl/LnOq5z
3. We still have merchandise available at www.hctmerch.com
4. Aaron's book "The Bad Food Bible: How and Why to Eat Sinfully" is available wherever books are sold, such as Amazon: amzn.to/2hGvhKw
Credits:
Aaron Carroll -- Writer
Meredith Danko - Social Media
Tiffany Doherty -- Writer and Script Editor
John Green -- Executive Producer
Stan Muller -- Director, Producer
Mark Olsen - Art Director, Producer
#healthcaretriage #spending #waste
The us insurance and billing systems does make up 30% of the costs.
This doesn't even consider general hospital management.
In Germany this makes up less then 6% of the total cost.
I was going to make a snide comment about shareholder dividends being the biggest source of waste, but dang, that’s a big chunk of the problem there
I watched a TED Talk by a healthcare lawyer who advocated that the reason everything is expensive is a loophole in the patent laws for drugs. They can be thousands of times cheaper, if the patents actually expired and weren't allowed (using the loophole of replace one ingredient with a different ingredient but maintain full patent rights for your "new" drug) to maintain drug monopolies. If the patent system was fixed, drugs would cost actual reasonable amounts. Just look at the difference in diabetes drug prices from the US to Canada.
Here's a study to do: check countries that allow the advertisement of random medication (such as the US) with those who do not. I would put money on the fact the countries that _don't_ allow it _measurably_ show that advertising creates hypochondriacs.
And also contributes to the opioid epidemic in the US, and so, so much more. I sometimes wonder how many of, like lead, the US's issues can be traced back to overmedication.
As an Australian, it's surreal and disconcerting seeing prescription medications advertised direct to consumer in the USA
I am concerned. This approach seems to equate care for high cost individuals with wasteful spending. But some people may just be sicker or suffering from poor environmental or social circumstances. I have a dialysis patient, for example, who is Spanish~speaking only and cannot read or write and has never been able to understand how to take his diabetes medicines. He is sweet and kind, but certainly not educated or particularly insightful. He is a high~cost -attention and till I got to him was in and out of ER. Does his care represent wasteful spending? That would imply the least wasteful way to care for sick patients is to let them die.
@@northernmetalworker Do you know how much time we waste as healthcare providers explaining to patients why a treatment they saw advertised is either not appropriate or will not be effective for them? Sometimes even after the discussion the patient is still adamant that they need this medication and will go elsewhere to find the med, or (if it won't cause harm and has some marginal justification) a provider may just prescribe it anyway, contributing to higher costs and wasted spending since that patient never needed it in the first place.
Edited for typos
@@DinoRamzi Dr. Carroll definitely does NOT suggest that letting people die is the way to deal with high costs.
@@steveh46 I know, but it certainly is an important point when talking about lowering costs. It is eugenic argument that would have appealed to many at the turn of the last century.
How about socialising healthcare and thus removing the profit motive from its provision?
the profit motive is being paid to administer the money - cut out the politicians
Because the profit motive remains, it just moves to another group United by a common interest.
The fact that EVERY OTHER DEVELOPED COUNTRY has figured this out, while we can't, says that the problem does not have anything to do with the patients or the care. The problem has to do with the financial incentives in the system. Anyone who does not openly discuss this is just covering up for the profiteers.
Excuse me. Pardon. Hello. Minor correction, if you'll permit:
Not can't. *Won't*.
Zionism
I went for a regular checkup this year. I have insurance (Blue cross blue shield) but they refused to pay so I had to cover $260. It was with an office they suggested and is on their partner list. The visit included Q&A, blood pressure, temperature, listening to breathing/heart, and a reflex test. I bombed the reflex test but there was no follow up. I did not see a doctor during the visit.
I know this is extremely minor in the grand scheme of healthcare spending, but it really hurts my confidence.
It seems to me that focusing on the cost of healthcare misses a big part of the picture. The cost of healthcare is centered on cost per sick person. If a more wholistic approach were adopted, focusing on the factors that make people sick in the first place, it may be possible to increase spending per sick person, but reduce cost per population, resulting in more sustainable and effective outcomes. For example dealing with unstable housing and nutrition to reduce the likelihood of developing exposure or nutrition based illnesses, like obesity, diabetes, rickets, frostbite, hypothermia, heat stroke and exhaustion, and others. All of these are relatively expensive conditions with relatively simple preventative measures.
I object that obesity and diabetes are not simple to prevent, and the other conditions are not a major burden to the healthcare system.
@@michaelmicek you misread my comment, and also where I live exposure related illness is one of the largest sources of healthcare expenditure outside of heart disease and diabetes. Considering that hypothermia, frostbite, heat stroke, and heat exhaustion are all mitigated by quality housing and access to clean water, infinitely cheaper to prevent than to treat repeatedly.
For the systematic approach, use Japan and Hong Kong as guides. For the individual approach, use Germany and Switzerland to reduce costs. This isn't rocket science; it's public health economics. About a decade ago, Taiwanese experts reduced costs by traveling to several countries (including the US) to study health care systems and ultimately implemented a form of universal health care. The real tragedy here is that while a pandemic rages on, the United States has neither a form of universal basic income nor a universal health care system.
Many east asian countries did far better in the pandemic by many dimensions
@@northernmetalworker The government can multitask: send social security direct deposits and have a standing army. It's asinine "to focus on one issue at a time."
@@northernmetalworker I called your _idea_ asinine. Also, part of addressing medical costs is having enough cash. Another part is having access to care. Again, this isn't rocket science. Developed nations and even some developing ones have better solutions. Ignoring them for profit continues to be highly detrimental to the US.
Healthcare waste is highly profitable and probably a relatively large part of the economy. There is little incentive to reduce it.
Yea screw the people needing their health to improve which would also be great for the economy as they can spend more on other services and products as well as fucking work to generate more money.
As an outsider (Australian) I view the American health insurance system as an expensive and inefficient middle man to health care. In Australia our private health insurance allows us to access private services quicker than the public system. But nobody actually needs insurance, removing a middle man which doesn't really serve much of a purpose in terms of delivering health care yet still costs a lot.
However with how powerful the health insurance lobbies are in the USA I highly doubt legislation targeting them will ever be brought in.
That's what the guillotines are for.
Good info
Getting a COVID vaccine will avoid high bills for time in the icu
How is "waste" defined? I'd think something only counts as waste if it provides no benefit compared to an alternative. A lot of health care might not be cost effective, but if it improves outcomes or patient experience at least some, it's hard to call it a complete waste.
Waste is anything with high expense and little to no use for example 30% of spending just for billing and the profits and cost of the private insurance.
@@paxundpeace9970 That makes sense intuitively, but what constitutes "high" cost and "little" use seems pretty subjective. 30% for billing is certainly inefficient, but are all billing costs considered waste, or only costs above a certain percentage? I'm know these studies have their own definitions of waste, but colloquially it seems like a vague term
The US health business has successfully combined the worst aspects of individualized and systemic approaches to health care for the worst cost-result-effectiveness outcome possible.
The only ones truly profiting from this system are the big pharma companies that currently charge an arm and a leg for their products with virtually no customer power countering their demanded prices. Because people that absolutely NEED a medical drug WILL pay any price that they can barely afford and continue living. Or they don't pay that price, weaken, sicken, and eventually die.
The insurance companies are the power that could counter the prices demanded by pharma companies, IF they united in a conglomerate, and denied any pharma companies the prices, and chose the cheapest producer out of a selection of providers. THAT would be a representation of company vs company, ie pharma vs insurance, which would be ideal for all invovled, including the patients. But no, that is 'socialism' or 'communism' in the words of many US politicians, if the government were to regulate the power of insurance companies that they could negotiate prices with the pharma companies. Until this mindset changes, pharma companies will continue to get away with outlandish prices for their products. Because a single end customer has no power against them: it is take the price or die.
💚💙💚
At this point im so sick of "make it more efficient" if we actually provided useful healthcare with somthing like individualized medicine, id wager we would see improvements. Im always happy to hear when your podcast is sponsored by that initiative.
It's just so strange seeing you bounce back and forth between indivdualize healthcare and make the system more efficient to reduce healthcare spending but using two seperate methods in many videos. Technically the ideas dont have to be separate but we often seem to analyze them as such and impliment policies that deal with them thay way too.
Now im certainly not disagreeing that the evidence in this video presents a flaw in our system but overall what do we actually take away from it, how do we actually improve healthcare?
A bit more long term, but, education for doctors and nurses seems to be way too expensive, especially considering there doesn’t seem enough of either at the moment
I follow a doctor on TikTok and he had one about how 80 hour weekly maximums had to be introduced so doctors didn’t work more? That’s insane. We need doctors to not work tired. Plus the burnout and turnover that encourages can’t be good for anything
I don't know that the cost is the problem.
Physician salaries are high enough to pay back loans and furthermore programs such as the National Health Service Corps exist which will pay for medical school in return for a service obligation.
The problem is just that not enough people who would be able to become physicians want the job.
@@michaelmicek I'm sure we'd have more doctors if we weren't burning out the ones we have
I'm sure more people would attempt to become doctors if the attempt didn't mean crippling debt
I don't have studies to back that up, but I find it hard to imagine the cost isn't putting people off
Same as most places- bureaucracy. No mention of the high overhead of administration is missing the forest for the trees.
Australia: what healthcare waste? 6% of GDP funds universal public healthcare?
I didn't really understand this.
wow Jones in 816 really does use a lot of resources, doesn't he?
Doc Schmidt?
@@peterhansen3401 Yep!
This sounds like the way companies decided to blame individuals for their carbon footprint instead of addressing their usage which is a MUCH larger contributor to greenhouse gas. And just like that the issue is really not with individual use the issue IS THE SYSTEM! We can dance around this all day but our for profit system incentivizes wastefulness! We need universal not for profit healthcare and to cut administrative bloat like every other developed country and several poorer countries too!
Took care of (just one hour a day) putting a severely disabled friend to bed for two nights (then quit as I knew I couldn't finish the last five nights) while her partner was in the hospital for a double knee replacement. She was already getting six hours a day by a highly trained aide. Think she should have been hospitalized or in a nursing home for the seven days. Am disabled myself and I wish I did not accept the task. Learned to never do this again!
Insurance companies say that deductibles exist to prevent wasteful spending. So just raise everyone deductible to “bankrupt”. Problem solved!
Destroy the profit motive
Something is odd. If they estimate 25% is waist then they know something about where the waste is. The studies cited seam to tyr to discover where it is and how to get instructions try to do something.
Get rid of the insurance companies in the health field and give us universal healthcare, problem solved.
You're forgetting: the US is somehow super diverse and thus proven solutions elsewhere can't possibly work there. Also, something about guns.
@@talideon Oh yeah, silly me.
We can't afford it though
@@troyhonda71 in some countries, all treatments were stopped and many people were beginning treatment for Stage III cancer ended up dying of that cancer because their treatment was stopped. Insanity that people want government officials like flip flopping Fauci controlling the healthcare system.
@@PowerSax911 You don't know how government funded health care works... do you?
903rd!
... I felt slightly nostalgic for the days of peeps shouting "I'm pre 311 views"...
Another area on waste are businesses that make their employees get unnecessary check-ups and get sick notes to take a day off. That just boils my blood
Mew ^_^
Everybody has ONE ID and there is ONE DATA BASE NATIONWIDE to all drs & pharmacies
Pulp the insurance companies and make a country that doesn't delight in cruelty.
I have zero faith in American healthcare.
The system itself is the problem, period. The system creates the conditions where superusers exist. It also creates the conditions for overpriced medical equipment, overpaid administrators, and overly complicated legal frameworks that make this a wicked problem.
Solution: end the American healthcare regime. Single payer models work in practically the entire EU, Japan, Canada, and Australia
How about make healthcare non-profit and get rid of companies that profit off healthcare? The approach in this video is doing it all wrong and ignoring the real problem.
Capitalism makes everything crappier.
Yes because socialist and communist healthcare is so much better 🙄
@@PowerSax911 Quality doesn't mean shit if you can't access it. America's sheer greed kills.
Thanks for your addition, some random troll from Eastern Europe.
@@PowerSax911 Actually, yes. Countries with a form of "socialised" healthcare do have better and more cost-efficient healthcare overall. And if you want an example of a straight-up communist country, take a look at Cuba. The US only looks good when specific (expensive) examples are taken, but has overall poor service delivery.
@@PowerSax911 more bang of the buck
Wow, you've bent over backwards to not give the proven answer; universal healthcare.